355TH Medgrp-Davis-Monthan

Primary specialty

Military/U.S. Coast Guard PharmacyTaxonomy code 332000000X

Legal business name

355TH MEDGRP-DAVIS-MONTHAN

Doing business as

Dod Davis Monthan Pharmacy

Practice address

5405 E Granite St
BLDG # 2527 Room # 127
Davis Monthan AFB, AZ 85707-3004

Phone

(520) 228-1924

Fax

(520) 228-2853

NPI assigned

Jun 19, 2014

Last updated

Jun 13, 2025By the provider in NPPES

Organization subpart

Yes

Parent organization

355TH MEDGRP-DAVIS-MONTHANAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Hector Morales

Title

Chief Dha Pass

Phone

(210) 536-6650

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DOD DAVIS MONTHAN PHARMACY Doing business as

Tax ID family

355TH Medgrp-Davis-Monthan2 organizations share this tax ID, including this one

Part of

355TH Medgrp-Davis-Monthan

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• 355TH Medgrp-Davis-Monthan

  • Military/U.S. Coast Guard Outpatient Clinic/Center
  • Tucson, AZ
  • NPI 1245210384
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Denise Fabian, M.D.

  • Psychiatry Physician
  • Davis Monthan AFB, AZ
  • NPI 1144457045
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749772800000",
    "number": "1366856155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355TH MEDICAL GROUP-DAVIS MONTHAN AFB HOSPITAL C/O STAF",
            "address_2": "4175 S. ALAMO AVE.",
            "city": "DM AFB",
            "state": "AZ",
            "postal_code": "85707",
            "telephone_number": "520-228-1924",
            "fax_number": "520-228-2853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5405 E GRANITE ST",
            "address_2": "BLDG # 2527 ROOM # 127",
            "city": "DAVIS MONTHAN AFB",
            "state": "AZ",
            "postal_code": "857073004",
            "telephone_number": "520-228-1924",
            "fax_number": "520-228-2853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "355TH MEDGRP-DAVIS-MONTHAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "355TH MEDGRP-DAVIS-MONTHAN",
        "enumeration_date": "2014-06-19",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A",
        "authorized_official_last_name": "MORALES",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_title_or_position": "CHIEF DHA PASS",
        "authorized_official_telephone_number": "210-536-6650"
    },
    "taxonomies": [
        {
            "code": "332000000X",
            "taxonomy_group": "",
            "desc": "Military/U.S. Coast Guard Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2146402",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOD DAVIS MONTHAN PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roosevelt Allen, DDS
• Tyler Antonelli, DDS
• Chad Bechtle, O.D.
• Alexa Bergren, DDS
• Haley Anne Berkowitz, LICSW

• Military/U.S. Coast Guard Pharmacy in Davis Monthan AFB, AZ
• Providers in Davis Monthan AFB, AZ by specialty
• Military/U.S. Coast Guard Pharmacy in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.